학위논문 (석사)-- 서울대학교 대학원 : 행정대학원 행정학과(정책학전공), 2018. 8. Jorg Michael Dostal.Generally, socioeconomically disadvantaged populations have a different health status. Their access to medical facility and health information are more restricted than the case of the general populations. If this disparity is accumulated for decades, it can affect the mortality and diseases epidemiology. Based on these results, vulnerable groups request a different health policy for themselves. However, there are not many nationwide researches for their actual health conditions. That means that rational and proper health policy cannot be established due to absence of these data.
The Korean government has been operating a national health insurance system for about 40 years. Today, this policy covers every single person residing in Korea for a period of at least one month. Due to this system, big data on national health has been built up electronically on a large scale. National health insurance offers three types of insurance programs for (1) the general population, (2) the medical aid group, (3) the patriots and wounded veterans groups. Among them, the medical aid group, patriots and wounded veterans groups could be defined as vulnerable population. Until now, there is no research on epidemiology and medical expense of vulnerable groups through nationwide health big data. Thus, the current dissertation conducts research on the frequency of each disease in vulnerable groups through big data analysis. This research can suggest more elaborate health policy for the vulnerable groups.
The health status of the last two groups was markedly different from the general population. The frequency of inflammatory infectious disease observed as the most common disease in general population decreased, and senile disorders such as chronic medical illness generally increased in vulnerable populations. Furthermore, the most common five diseases group in patriots and wounded veterans group were totally differenthypertension, benign prostate hyperplasia, diabetes mellitus, gingivitis and periodontitis, and angina pectoris. With regard to medical expenses, the largest part of the budget was spent on the musculoskeletal disease group in the general population. Secondly, mental disorders such as schizophrenia and dementia consumed the largest portion in the medical aid group. Thirdly, chronic medical illnesses such as diabetes mellitus, angina pectoris, chronic kidney disease are the major medical expense items in patriots and wounded veterans. This situation might be due to the ageing phenomenon within the veterans group. Regarding differences in the health status between the three groups, they require delicate health policies such as the expansion of health security system, health care delivery system based on integrated primary complex intervention, mobile health and home care based on the high-tech technology, the globalization of health care policy, sustainable finding of the neglected class.
The present study has the following limitationWe could not control other independent variable such as age, sex, chart review and laboratory findings. Moreover, we excluded non-insurance coverage health care and extreme poverty groups. Uncertainty of entered diagnostic codes could be another limitation because of health insurance coverage system. However, this study is the first big data study of the nationwide population based on retrospective analysis about the frequency of diseases in vulnerable groups. Thus, as the complete enumeration, it offers higher reliability and validity in comparison to single or multi - center sample studies. Henceforth, it provides fundamental information for more practical study founded on social class and each specific disease.Abstract 1
Table of Contents 3
List of Tables and Figures 5
Chapter 1. Introduction 7
1.1 Health care as public policy
1.2 The inequality of health problem across social classes
1.3 Ageing phenomenon
1.4 Health supporting policy for vulnerable groups under the present circumstances
1.5 Purpose of the research
1.6 Research questions
1.7 Hypothesis of the research
Chapter 2. Literature review 15
2.1 Comparative health policy
2.2 Categorization of health care system
2.3 The introduction of the Korean National Health Insurance system
2.4 Emerging financial problem in the health care
2.5 The features of health information in medically poor group
2.6 Actual health and socioeconomic conditions of patriots and wounded veterans in Korea
Chapter 3. Materials and Methods 21
3.1 Data source and study design
3.2 Study populations
3.3 The frequency of each disease and a comparison with a general population
3.4 A comparison of each groups total medical expenses
3.5 Statistical analysis
Chapter 4. Results 24
4.1 The prevalent diseases of the general population
4.2 The prevalent diseases of the medical aid group
4.3 The prevalent diseases of the patriots and wounded veterans group
4.4 A comparison of each groups frequent diseases
4.5 The variable patterns of significant diseases over five years
4.6 A comparison of total required medical expenses in three groups
Chapter 5. Discussions 47
5.1 Definition and socioeconomic characteristics of vulnerable populations
5.2 Different health status of two vulnerable populations(1) the medical aid group, (2) the patriots and wounded veterans group
5.3 Medical expenses depending on the social class and disease severity
5.4 Current condition of health support for vulnerable population
5.5 Policy implication for the future
5.6 The limitations and strength of this study
Chapter 6. Conclusions 57
Bibliography 58
국문초록 61Maste
